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Personal Coaching Survey

This brief survey is designed to measure key areas of your life
that affect your journey towards living life at its fullest.
Usually the first response that comes to mind is the best one.
Be honest. Be passionate. Have Fun!

To assure you receive the results of your survey, please double check
the accuracy of your email address in the box below.

Your Name:
Your E-mail:

Please indicate how well you are doing in each of the following areas
by selecting a number from 1 through 10.

You may also enter thoughts you might have for each statement.

1. My professional work is in alignment with my personal goals, e.g., time for family, hobbies and special interests.
1 2 3 4 5 6 7 8 9 10
   Almost Never         Sometimes Usually Almost Always

Thoughts:
2. I’m achieving my financial goals, e.g., income, retirement, children’s education.
1 2 3 4 5 6 7 8 9 10
 Unacceptable  Need major change Need fine-tuning Doing Well

Thoughts:
3. I utilize written action plans to achieve specific short-term goals.
1 2 3 4 5 6 7 8 9 10
   Almost Never         Sometimes Usually Almost Always

Thoughts:
4. I Assess my progress towards my goals on a timely basis, i.e. – quarterly, semi-annually, annually.
1 2 3 4 5 6 7 8 9 10
   Almost Never         Sometimes Usually Almost Always

Thoughts:
5. I invest in myself to upgrade the necessary skills to achieve my goals, i.e. – classes, retreats.
1 2 3 4 5 6 7 8 9 10
   Almost Never         Sometimes Usually Almost Always

Thoughts:
6. I develop a network of successful people I respect to give me objective feedback on my skills and actions.
1 2 3 4 5 6 7 8 9 10
 Unacceptable  Need major change Need fine-tuning Doing Well

Thoughts:
7. I lead by example to change what needs to be changed to better perform at work.
1 2 3 4 5 6 7 8 9 10
   Almost Never         Sometimes Usually Almost Always

Thoughts:
8. I create an environment that fosters learning and personal growth at work and at home.
1 2 3 4 5 6 7 8 9 10
   Almost Never         Sometimes Usually Almost Always

Thoughts:
9. I often think, “If ‘x’ was different, I’d be happy!”
1 2 3 4 5 6 7 8 9 10
   Almost Never         Sometimes Usually Almost Always

Thoughts:
10. I turn seemingly negative events into positive motivation.
1 2 3 4 5 6 7 8 9 10
   Almost Never         Sometimes Usually Almost Always

Thoughts:

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